Immunological and clinical effects of stem cell therapy in systemic lupus erythematosus: a review of clinical trials and animal studies

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with diverse clinical manifestation arising from an abnormal immune response to self-antigens. The exact etiology of SLE is unknown, but genetic and environmental factors are likely to be important in the etiology and pathogenesis. Conventional therapy for patients with SLE include corticosteroids, hydroxychloroquine, and nonsteroidal anti-inflammatory drugs (NSAIDs). Complications associated with conventional therapy in patients with SLE as well as resistance and tolerance to conventional therapy have led to a shift to new methods of therapy. Major characteristics of stem cells such as the ability to undergo long-term self-renewal and their capacity for pluridifferentiation has introduced them as therapeutic candidates. Clinical trials using stem cells for the treatment of SLE have increased progressively over the last ten years, and the efficacy and therapeutic effects of this therapy method have been evaluated in several studies. This article aimed to review the immunological and clinical effects of stem cells from different sources such as hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), and induced pluripotent stem cells (iPSCs) in the treatment of patients with SLE published in ISI Web of Science and PubMed databases from 2000 to 2020. The relevant data regarding animal models of SLE is also reviewed. HSCs and MCSs are the most common source of stem cells employed for the treatment of SLE. Stem cell therapy might influence immune response in patients with SLE leading to decrease in autoantibodies and ameliorate disease activity and renal injury. Regardless of controversies in the results of studies that may be due to patient selection criteria, source of stem cells and dose of intervention, it seems that stem cell therapy in SLE has immunomodulatory effects which exhibit clinical remission and improve quality of life.